Healthcare Provider Details

I. General information

NPI: 1548288921
Provider Name (Legal Business Name): MICHAEL MARION GASPARI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 05/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 BILLINGSLEY RD STE 200
CHARLOTTE NC
28211-1084
US

IV. Provider business mailing address

300 BILLINGSLEY RD STE 200
CHARLOTTE NC
28211-1084
US

V. Phone/Fax

Practice location:
  • Phone: 704-372-7974
  • Fax: 704-372-5166
Mailing address:
  • Phone: 704-372-7974
  • Fax: 704-372-5166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number26533
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: